| [Objective] Cataract is a major blinding eye disease worldwide, so far, combined cataract extraction and intraocular lens implantation surgery is still recognized as the most effective means of treatment of cataract. Cataract surgery becoming perfect, has become a significant refractive surgery, cataract surgery has become the first choice for the majority of ophthalmologists in surgical treatment of cataract. Ultrasonic phacoemulsification will do some damage to eye tissue,so minimizing the ultrasonic energy to reduce the eye tissue injury has been a topic of concern for ophthalmologists. A new type of ultrasonic emulsification mode-torsional mode, can improve the efficiency of phacoemulsification to reduce corneal endothelial damage. The purpose of this study is to explore the efficiency and safety of hybrid power mode ultrasound (torsional mode phacoemulsification combined with reciprocating mode ultrasound power).[Methods] This research is Prospective. All the subjects comprised 266 patients(291 eyes) which came from the Jinan central hospital affiliated Shandong University and were diagnosed as age-related cataract.The patients were registered by the order and randomly divided into conventional ultrasound mode group (reciprocating mode) with 97 eyes and hybrid mode group with 98 eyes and torsional mode group with 96 eyes. Diseases affecting vision were excluded preoperative. All patients had phacoemulsification through a 2.2mm clear corneal incision by ultrasound mode, hybrid mode and torsional mode respectively.The intraoperative data of Ultrasound Time (UST) and Cumulative Dissipated Energy (CDE) were measured and compared. Postoperative outcome measures including corneal clarity,the best corrected visual acuity (BCVA), central endothelial corneal cell counts, and the corneal endothelial cells loss rate were also measured and compared.[Results] In the conventional ultrasound mode,the UST were gradeⅡ17.80±5.55 seconds, gradeⅢ30.54±5.23 seconds,gradeⅣ-Ⅴ52.01±15.43 seconds. In the hybrid mode group, the UST were gradeⅡ14.22±3.99 seconds, gradeⅢ23.46±6.00 seconds, gradeⅣ-V38.93±12.09 seconds. In the torsional mode group, the UST were gradeⅡ13.75±6.03 seconds, gradeⅢ25.65±5.42 seconds, gradeⅣ-Ⅴ39.62±11.46 seconds. Comparison between the three groups showed significant differences, P＜0.05.In the conventional ultrasound mode group, the CDE were gradeⅡ5.84%±2.23%, gradeⅢ10.66%±3.06%, gradeⅣ-Ⅴ18.79%±5.46%. In the hybrid mode group, the CDE were gradeⅡ3.88%±1.74%,gradeⅢ8.47%±1.79%,gradeⅣ-Ⅴ14.82%±5.57%. In the torsional mode group, the CDE were gradeⅡ3.65%±1.72%, gradeⅢ8.23%±3.04%, gradeⅣ-Ⅴ14.85%±4.33%. The differences between the three groups were statistically, P＜0.05. UST and CDE inⅡ,ⅢandⅣ-Ⅴgrade hardness of the nucleus, the ultrasound mode group was higher than hybrid group and torsional mode group, and increases with the nuclear hardness increasing, the difference was statistically significant. There were no differences between the hybrid group and torsional mode group.At postoperative 1 day and 7 days, degree of postoperative corneal edema of the hybrid mode group and the torsional mode group showed less corneal edema than in the conventional ultrasound mode group, and the differences were statistically significant, P＜0.05. At postoperative one month, the three groups had no corneal edema. At postoperative 1 day and 7 days, the postoperative best-corrected visual acuity(BCVA)in hybrid mode group and the torsional mode group was better than in the conventional ultrasound mode group,and the differences between the three groups were statistically significant,P＜0.05. At postoperative one month, there were no differences between the there groups, P＞0.05. At postoperative 7 days and 30 days, corneal endothelial counts in the hybrid mode group and the torsional mode group were greater than the conventional ultrasound mode group, and the corneal endothelial loss rate were lower than the conventional ultrasound mode group.The differences were statistically significant, P＜0.05.[Conclusion] The hybrid mode ultrasound is similar to the torsional mode,it not only can reduce the intraoperative ultrasound energy and ultrasonic time,but also can increase in core followed, reduce repulsion and improve the emulsification efficiency. The hybrid mode ultrasound significantly reduce the intraocular trauma and the cornea recover faster than the conventional ultrasound mode group,so it can get a good visual effect in Short period of time. The hybrid mode ultrasound is safer and more effective than conventional ultrasound mode, which superior to the torsional mode in reducing blocked pipes and mitigating the anterior chamber pipe fog especially in the hard-core processing. |
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